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PANCE > 10. Psychology > Flashcards

10. Psychology Flashcards

1
Q

hearing voice all the time + believes FBI telling him to do something

4 type Name/Criteria/Risk/Tx

A

Name: schizophernia

  • Brief psychotic disorder: <1 month
  • Schizopheniform: <6 month
  • Schizophrenia: >6 month
  • Schizoeffective disorder: schizophernia + mood disturbance

Criteria

  1. Positive sx (hallucination, delusion) - excessive dopamin
  2. Negative sx (flat emotional effect) - dopamin dysfuntion
  • >2 of more (but must have 1 positive)

Risk: Strong family hx

Tx: Antipsychotic - 2nd gen - risperidone, olanzapine, quetiapine

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2
Q

hx of taking 1st gen psychotic medication + protusion of tongue, trimus, facial grimacing

Name/Medication/Tx

A

Name: Dystonic reaction (dyskinesia)

Medication: haloperidol, chlorpromazine

Tx: diphenhydramine IV or add benztropine

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3
Q

hx of taking 1st gen antipsychotic meds + repetitive move involve face and extremities such as lip smacking, rolled tongue

Name/Medication

A

Name: Tardive drykinesia

Medication: haloperiol, chlorpromazine(thorazine)

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4
Q

hx of taking 1st gen antipsychotic meds + mental status change + hyperthermia/fever

Name/Medication/Tx

A

Name: Neruoleptic malignant syndrome (NMS)

Medication: haloperidol, chlorpromazine (Thorazine)

Tx: Stop offending agent + cooling blanket & ice + dopamine agonist (bromocriptine)

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5
Q

1st gen antipsychotic

Medication/MOA/SE

A

Medication: Haloperidol, Chlorpromazine (Thorazine)

MOA: dopamin antagonist

SE: EPS(DR,TD)/NMS/prolactin increase/weight gain

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6
Q

2nd gen antipsychotic

Medication/MOA/benefit over 1st/SE

A

Meidcation: olanzapine, quetiapine, clozapine

MOA: dopamin/serotonin antagonist

Benefit: less EPS

SE: Clozapine must check CBC weekly due to cause agranulocytosis and myocarditis, Olanzapine cause weight gain

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7
Q

1st line for bipolar medication/SE/CI

A

Medication: Lithium

MOA: Norepi, serotonin sensitivity

SE

  • hypothyroidism
  • due to narrow theraputic index check serum level every 5-7 days (0.6-1.2 MEG normal, anything above 1.5 go ER),
  • Increase thirst and urination (must drink 8-12 glasses of water/day)

CI: Pregnancy (teratogenic - ebstain anomaly)

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8
Q

Insomnia + Feeling worthless + sx has been more than 2 weeks

Name/Dx/Lab/Tx

A

Name: Major depression disorders

Dx: PHQ 2 (1st) - More than 3 point or above use PHQ9 -> PHQ9 more than 10 point -> start tx

Lab: TSH (hypo), anemia, Vit D

Tx

  1. Psychotherapy (cognitive)
  2. SSRI, SNRI (1st), Bupropion (2nd) - requires 3-6 weeks to determin efficacy
    • If failed 2 medication therapy, add bupropion -> refer out psych
  3. Electroconvulsive therapy (ECT)
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9
Q

1st line for MDD

medication list/MOA/Benefit/SE

Q: Which mediction is not approved to use for pediatric?

A

Medication

  • sertraline - Night meds (tends to clam down)
  • citalopram, escitalopram
  • paroxetine, fluoxetine - morning meds (tends to active)

MOA: Serotonin

Benefit: Less S/E, low toxicity

SE: sexual dysfunction, Serotonin syndrome (acute alter mental status, seizure)

Ans: Paroxetine

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10
Q

Pt has chronic pain + hot flash

Medication list/MOA/SE

A

Medication: Venlafaxine, desvenlafaxine, duloxetine

MOA: Serotonin, Norepi, dopamine

SE: HTN

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11
Q

TCA (tetracyclic antidepressants)

Medication/MOA/SE

A

Medication: Amitriptyline, Clomipramine, Desipramine

MOA: Serotonine & norepi

S/E: severe toxicity with overdose (anticholinergic effect, prolong QT, wide complex tachycardia)

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12
Q

Pt need smoking cessation help

Medication/MOA/SE/Benefit/CI

A

Medication: Bupropion

MOA: Dopamin & norepi

SE: weight loss

Benefit: Less GI distress & sexual dysfunction compared to SSRI

CI: hx of seizure disorder (lower threshold)

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13
Q

Pt states medication cause severe sedation used it for depression

Medication/SE/Benefit

A

Medication: Mirtazapine

SE: sedation, weight gain

Benefit: Fast action (2-3weeks effect)

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14
Q

spend a lot of money + grandiose + pressure speech + not sleeping enough

Name/Risk/Dx/Tx

A

Name: bipolar I

Risk: family hx

Dx: Mania at least 1 week

  • Mood: euphoria, irritable
  • thinking: racing, spending sprees, flight of ideas
  • behavior: pressure speech, decrease need for sleep, pleasure activity including risk-taking, & hypersexuality

Tx: Lithium (1st), if agitation - benzo should add

  • Cognitive therapy
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15
Q

irritably mood with 4 days clearly different from the usual nondepressed mood, but does not caused marked impairment, no psychotic features & does not requires hospitalization

Name/Dx/Tx

A

Name: Bipolar II

Dx: hypomania with 4 days of sx

Tx: Lithium (1st)

  • Cognitive therapy
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16
Q

Chronic depressed mood 2 year or more + still able to function + pt states i’ve always been this way

Name/Tx

A

Name: persistent depressive disorder

Tx: Psycotherapy (1st), SSRI

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17
Q

Pt thought about future + sudden starting having chest pain, palpitation, SOB

2 type Name/possible additional/Tx

A

Name: Panic attack/disorder

  • attack - brief attack
  • Disorder: recurrent (at least 2 attack)

Possible additional: Agoraphobia - anxiety about being in places or situation

Tx: attack - benzo, Disorder - SSRI (1st), Cognitive therapy

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18
Q

excessive worrying more than 6 month + fatigue

Name/Dx/Tx

A

Name: general anxiety disorder

Dx: GAD-7 (score more than 10 tx), Review coffeine, and substance hx

Tx: SSRI with CBT (1st), Buspiron (2nd) - doesn’t cause sedation

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19
Q

fear of public speaking, meeting new person cause panic attack x more than 6month

Name/Tx

A

Name: Social anxiety disorder

Tx: CBT + SSRI

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20
Q

intense fear of snakes, blood, height + more than 6 month

Name/Tx

A

Name: specific phobia

Tx: Exposure therapy

  • Maybe use short term - benzo
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21
Q

Re-experiencing more than 1 month (flashback) + hx of trauma

Name/Tx

A

Name: PTSD

Tx: SSRI + CBT

  • Trazodone for insomnia
22
Q

Flashback experience of trauma + less than 1 month

Name/Tx

A

Name: acute stress disorder

Tx: CBT, if persistant - PTSD tx

23
Q

Lost of job, divorce, cause interferrence of daily function

Name/TX

A

Name: Adjustment disorder (temporary less than MDD)

Tx: psychotherapy, usually resolve in 6 month

24
Q

Dissociative disorder 3 type and explain

A
  • Dissociative identity disorder - presense 2 distinct identity
  • Depersonalization/derealization disorder - focused on movies and unable to hear or see anything surround
  • Dissociative amnesia - inability to recall personal/autobiographical information
    • Dissociative fugue - abrupt change in geographic location
25
Q

Recurrent thought + repetitive behavior

Name/4 major pattern/Tx

A

Name: OCD (obessesive-compulsive disorder (OCD)

4 Major pattern

  • contamination - keep cleanning
  • pathologic doubt - forget turn off iron
  • symmetry/precision - perfection arrange
  • intrusive obsessive thoughts - keep thinking over and over

Tx: SSRI + CBT

26
Q

Pt does not like one or more of their body parts + often check mirror image of their body

Name/Tx

A

Name: Body dysmorphic disorder

Tx: SSRI + psychotherapy

27
Q
  1. True sx but unable to find cause - Name/Tx
  2. Preoccupation with the fear or belief one has or will contract a serious disease - Name/Tx
  3. pt complains of neruologic dysfunction but can’t be explained clinically (paralysis, mutism, seizures) - Name/Tx
  4. intentional falsification of signs and symptoms but not for personal gain (creation of sx, or willing to undergo surgery) - Name/Tx
  5. Intentional falsification of sign and symptoms and SECONDARY GAIN - Name/Tx
A
  1. somatic disorder - Tx - regular appt with health care provider
  2. illness anxiety disorder (hydrocondriasis) - Tx- Regular appt with health care provider
  3. Conversion disorder - Tx - psychotherapy
  4. factitious(munch) disorder - Tx - None
  5. Malingering disorder - Tx - None
28
Q

Abuse 3 type and examples

A
  • Sexual abuse - genital/anal trauma, STD
  • Physicial abuse - ciggarette burns, buns in a stocking glove pattern, healed fracture in X-ray, bruises
  • Child neglect - malnutrition, poor hygiene and failure to thrive
29
Q

BMI more than 30 + binge eating at least weekly for 3 month

Name/Tx

A

Name: Obesity

Tx: Orlistat, lorcaserin

30
Q

Women + BMI less than 17.5

Name/PE/Dx/Lab value/Tx

A

Name: anorexoa nervosa

PE: hypotension, bradycardia

Dx: BMI less than 17.5

Lab: hypokalemia

Tx: Olanzepine

  • hospitalization if less than 75% body weight
31
Q

binge eating + purging type

Name/PE/Lab/Tx

A

Name: Bulimia nervosa

PE: teeth pitting or enamel erosion, Russell’s sign (calluses on the dosrsum of the hand)

Lab: HypoK, HypoMg

Tx: CBT (1st) + Fluoxetin

32
Q

Classification Cluster A,B,C

A

Cluster A - schizoid, schizotypal, paranoid

Cluster B - antisocial, histrionic, narcissistic, boarderline

Cluster C - dependent, OCD, acoidant

33
Q

pt likes to be alone + no response to praises or criticism

Name/Tx

A

Name: Schizoid

Tx: Psychotherapy

34
Q

pt believes superstition, bizarre fantasies but no signs of delusion

Name/Tx

A

Name: Schizotypal

Tx: Psychotherapy

35
Q

pt has significant mistrust/suspiciousness toward to others

Name/Tx

A

Name: Paranoid

Tx: Psychotherapy

36
Q

Drunk-Driving + shows no little anxiety + often implusive and lack of empathy

Name/Tx

A

Name: antisocial

Tx: Psychotherapy

37
Q

Significant mood swing + black & white thinking + unstable relationship

Name/Tx

A

Name: Boarderline

Tx: Psychotherapy (dialectic behavioral therapy)

38
Q

seek for attention to others + likes to get prasises and reassurance + inappropriate sexually provocation

Name/Tx

A

Name: Histrionic

Tx: Psychotherapy

39
Q

Grandiose often excessive of self-importance (inflated self image)

Name/Tx

A

Name: Narcissistic

Tx: Psychotherapy

40
Q

pt with timid, shy & lack of confidence

Name/Tx

A

Name: Avoidant

Tx: Psychotherapy (may be use BB for anxiety)

41
Q

Avoiding eye contact + no communication with others + repetitive pattern

Name/Tx

A

Name: Autism

Tx: Neuropsychologic testing

42
Q

Constantly asking for assurance + difficulty of decision making + relies on others

Name/Tx

A

Name: dependant

Tx: Psychotherapy

43
Q

Children with angry/irritable mood + blamming for others + arguments often with adults x 6 month

Name/Tx

A

Name: Oppositional defiant disorder

Tx: Psychotherapy

44
Q

Children who aggressive/cruel to animal + stealing, lying, sets fire backyard + breaking law often

Name/Tx

A

Name: Conduct disorder

Tx: Psychotherapy (Poor prognosis) - often develop antisocial

45
Q

Children 11 yo constantly talking and impatient + distract easily + hard to focus on task or hard to sitting quitely for long period time

Name/Dx/Tx/MOA stimulant/MOA nonstimulants

A

Name: Attention deficit hyperactivity disorder (ADHD)

Dx: on set before 12 yo, at least 6 month of period consistancy

Tx: Behavior modification + stimulants (methylphenidate, amphetamine) or nonstimulants (atomoxetine)

MOA stimulants - Block dopamin/norepi reuptake

MOA nonstimulants - Block dopamin

46
Q

hx of smoking + hasn’t smoked for 2 days + restlessness

Name/Tx

A

Name: tabacco dependence

Tx: Counselling/CBT

  • Nicotine tapering therapy - gum, transdermal, inhaler
  • Bupropion
  • Varenicline (Chantix)
47
Q

Pupil constrict + breathing difficulty

Name/Tx

Pupil dilated + sweating + piloerections (googe bump)

Name/Tx

A

Name: Opioid intoxication

Tx: Naloxone (Narcan)

Name: Opioid Withdrawal

Tx: Clonidine, Buprenorphine + naloxone (suboxone)

  • Methadone tapering (may use benzo)
48
Q

long hx of ETOH + restlessness + tachycardia

Name/4 category/Tx

A

Name: Alcohol withdrawal

4 category

  • Uncomplicated alcohol withdrawal - 6-24 hrs (tremor, palpitation - increase CNS)
  • Withdrawal alcohol - 6 - 24hrs with generalized seizure (tonic clonic type)
  • Alcoholic hallucinosis - 12-48 hrs with hallucination
  • Delirium tremens - 2 - 5 days delirium + abnormal vital sign

Tx: IV Benzo (zepam meds) + IV thiamine & Mg

49
Q

slurred speech + impaired attention

Name/Tx

Alcohol depence screening and management explain

A

Name: Alcohol intoxication

Tx: Observe

  • Chronic - IV thiamine & megnesium

Alcohol dependence screen - CAGE (2 or more Consider as positive)

  • Cutdown - tried?
  • Annoyed - people told him
  • Guilt - feel guilt?
  • Eye opener - needed eye opener

Tx: disulfiram, Naltrexone

50
Q

4 important Suicide risk/2 Method/Tx

A

Risk

  • Previous attempt (strongest)
  • Female attempt higher, but male complete suicide than female
  • Elder white men sucide highest in US
  • Marriage and children has lowest chance to sucide (protection)

Method

  1. gun (possesion increase chance 4 times high)
  2. hanging, poisoning

Tx: Safety is primary tx, counselling

51
Q

death of loved one x less than 1 year

Name/Difference/Tx

A

Name: Grief Reaction

Difference VS MDD - self-esteem preserved (MDD - feeling worthlessness)

Tx: Psychotherapy

PANCE (12 decks)

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